Peter Sumarsono Professional Dental Corporation

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

40736 Issued in CA

Legal business name

PETER SUMARSONO PROFESSIONAL DENTAL CORPORATION

Practice address

4605 Barranca Parkway., 200
Irvine, CA 92604

Phone

(714) 864-8261

NPI assigned

Oct 27, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Caroline Sumarsono

Title

Office Manager

Phone

(714) 864-8261

Specialties & licenses 1

Addresses

Tax ID family

Peter Sumarsono Professional Dental Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Peter Sumarsono Professional Dental Corporation

  • Preferred Provider Organization
  • Huntington Beach, CA
  • NPI 1033596788
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1326443920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 BARRANCA PKWY STE 200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926041729",
            "telephone_number": "714-864-8261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 BARRANCA PARKWAY., 200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92604",
            "telephone_number": "714-864-8261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER SUMARSONO PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-27",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "SUMARSONO",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "714-864-8261"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "40736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter an Truong, DDS, Ms Inc. (Mint Orthodontics)
• Peter C Kim DPM Inc (Irvine Foot & Ankle Care)
• Peter D. Cancellier, DDS, Apc (Endodontics of Orange County)
• Peter Lim DDS (Renew Dentistry of Irvine)
• Peter R. Welgan, PH.D, Inc.
• Ashley Nicole Peterman, PA-C
• Chad A Peters, DMD
• Jerriann Peters, PSY.D.
• Lindsey Peters, LMFT
• Makayla Peters

• Preferred Provider Organization in Irvine, CA
• Providers in Irvine, CA by specialty
• Preferred Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.